Finance and Reimbursement

APRNs and Medicare

Learn more about how APRNs can contribute to the valuation of nursing services

Brief Backgrounder: How Medicare Pays APRNs: Fee for Service and Medicare Advantage

Improving Medicaid Reimbursement
APRNs should receive appropriate reimbursement from Medicaid. For additional information on key policy issues, visit the Advanced Practice Medicaid Reimbursement page.

Read about a change to the Medicare rule reducing payments for those not using electronic prescribing. The rule has been delayed and clinicians with limited prescribing activity are now exempt.

Monitoring New Payment Models
ANA policy staff closely monitor proposed changes in payment models, with a special emphasis on how they will impact payment to APRNs. Read about the impact of MACRA - the Medicare Access and CHIP Reauthorization Act.

APRN Distribution in Urban and Rural Areas of the United States
This study examined the CMS NPI data on APRNs to examine the relative rural distribution of selected APRNs based on their recorded zip code of practice location. NPs and CRNAs were more found more likely to practice in rural locations in states with greater practice autonomy, especially CRNAs. Male NPs and CRNAs were more likely than females to be in rural locations. Efforts to encourage more men to choose careers as NPs or CRNAs would likely benefit rural communities. Of course, further research is needed to more fully understand factors that influence decisions to practice in rural areas.

APRNs with a National Provider Identifier [PDF]
APRNs across the U.S. have obtained a National Provider Identifier that facilitates their electronic direct billing to Medicare, Medicaid, and private health plans. By obtaining NPIs, APRNs can help give a good picture of billing and reimbursement.

From the Medicare Learning Network: "Medicare Information for Advanced Practice Nurses and Physician Assistants" Booklet
A Medicare Learning Network^® booklet titled “Medicare Information for Advanced Practice Nurses and Physician Assistants” (September 2010) is designed to educate advanced practice nurses (APN) and physician assistants (PA) on Medicare requirements. This publication provides information about required qualifications, coverage criteria, billing, and payment for Medicare services furnished by APNs and PAs.